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Some parents worry babies get ‘too much too soon,’ but study finds no impact on neurological health

MONDAY, May 24 (HealthDay News) — Some American parents are choosing to space out and delay recommended vaccines because they’re worried that their infants are getting too many shots too soon, potentially contributing to later mental health issues.

The issue has been especially persistent when it comes to autism, which some believe is tied to vaccines, although numerous studies have discounted such a link.

However, a study published online May 24 in the journal Pediatrics finds no neurological benefit to delaying immunizations during the first year of life.

Researchers at the University of Louisville analyzed the health records of more than 1,000 children. After comparing the kids’ performance on 42 neuropsychological tests between the ages of 7 and 10 against the timeliness of vaccination during the first year of life, the researchers found no evidence that delaying vaccines gave children any advantage in terms of brain development.

“Our study shows that there is only a downside to delaying vaccines, and that is an increased susceptibility to potentially deadly infectious diseases,” said lead researcher Dr. Michael J. Smith, a pediatric infectious diseases specialist at the University of Louisville School of Medicine. “We hope these findings will encourage more parents to vaccinate according to the American Academy of Pediatrics schedule, and reassure them that they’re making a safe choice when they do so.”

Smith said the study is the first to evaluate the long-term neuropsychological impacts of multiple vaccinations received in the first seven months of life. In the past few years, more and more parents are asking their pediatricians for an alternative vaccine schedule, “but we found that nobody had really looked at whether there are any advantages to delaying vaccines,” he said.

Using publicly available records collected for a previous study of exposure to the vaccine preservative thimerosal, Smith and co-author Dr. Charles Woods reviewed the immunization records of 1,047 children born between 1993 and 1997, as well as their performance on 42 in-depth neuropsychological tests taken between 2003 and 2004. Children were classified as up-to-date if they had received at least two hepatitis B, three diphtheria-tetanus-pertussis (DTP), three Haemophilus influenzae type B (Hib) and two polio vaccines on time during the first seven months of life. A vaccine was considered on time if it was given within 30 days of the recommended age.

The developmental tests included assessments of speech and language, fine motor coordination, behavior regulation, general intellectual functioning and other abilities.

Two separate analyses were performed. In the first, children with timely receipt of vaccination were compared to all other children in the study who had delays in receipt of one or more doses. In a second analysis, children who received the maximum number of vaccines in the first seven months of life were compared to those who received the fewest vaccines in the study group.

In both analyses, the researchers found no evidence to suggest that multiple vaccines in the first year of life negatively impact a child’s cognitive abilities later. In fact, the first analysis revealed that children who received all their vaccines on time performed slightly better on two of the 42 tests, after adjustment for familial and socioeconomic factors. Kids who missed or were late on one or more doses of vaccine didn’t do better on any test.

Vaccine expert Dr. Gary L. Freed, director of the Child Health Evaluation and Research Unit at the University of Michigan Health System, said he wasn’t surprised by the findings, since “there’s never been any evidence whatsoever that delaying vaccines does any good for any child.” And the reason children receive so many vaccines at such young ages is because “the life-threatening diseases that they protect against are most likely to attack at these ages,” he said.

Are parents forced to vaccinate their children? Are vaccines mandatory in the U.S.? This is a question that worries many parents, and it is a claim that is made very confidently by many in the anti-vaccine crowd, and it appears the answer is yes, and no. The CDC has a recommended immunization schedule that most pediatricians follow. That schedule is not mandatory and many parents work with their pediatricians to come up aith alternate schedules, even though they may be going against their pediatrician’s advice when they choose to do that.

Nevertheless, we don’t live in isolation in a mountain top; we live in a society which has rules to protect the whole, and vaccines are no exception. Most states require children to be up to date with their vaccination schedule in order to attend day care centers or public schools (I am not sure how private schools handle this, so for the sake of the argument let us assume they follow the same guidelines as public ones). Those same states, on the other hand, provide opportunities for parents to exempt their children from the vaccination requirements. In this entry we will review the legal requirements, and what exemptions are available to parents when it comes to vaccinating their children.

The best sources of information in regards to this issue that I have been able to find are reports prepared for the U.S. Congress by the Congressional Research Service, CRS, a think tank that provides reports to members of Congress on a variety of topics relevant to current political events, whose mission statement reads as such:

CRS is committed to supporting an informed national legislature — by developing creative approaches to policy analysis, anticipating legislative needs and responding to specific requests from legislators in a timely manner. With a rigorous adherence to our key values, CRS provides analysis that is authoritative, confidential, objective and nonpartisan.

The CRS prepared reports titled “Mandatory Vaccinations: Precedent and Current Laws” which seem to have been compiled by different attorneys at different points in time. For example I found this one, dated 10/26/09 by Kathleen S. Swendiman; this one from Angie A. Welborn last updated on 01-18-05. A couple of earlier versions of Swendiman’s report can also be found at the opencrs website. Keep in mind that these are reports compiled by attorneys and were provided to the U.S. Congress, as such I consider the information in here to be of the highest quality. So what do these reports say about mandatory vaccinations?

The thing to keep in mind when discussing the laws regarding mandatory vaccinations, is that this is mainly a state law issue, as opposed to a federal law issue. With very limited exceptions, “the preservation of the public health has been the primary responsibility of state and local governments“. Also, “current federal regulations do not include any mandatory vaccination program” (Summary).

States on the other hand do have laws in place mandating that children attending day care centers or schools are up to date with their vaccine schedule. The CDC has a nice page with information on mandatory vaccinations by vaccine, by state. Pick a vaccine, pick a level of schooling and you get a table with state-by-state information about the mandatory requirements for the specific vaccine.

If you want to dig more deeply, you will have to research the statute of your state to learn everything on mandatory vaccinations & exemptions. I will not do a state by state analysis, instead I will defer to the Swendiman 10/26/09 report. Here is a synopsis of the main points the report makes:

The preservation of the public health is the primary responsibility of state and local governments, not the federal one.

State/local governments have the power to institute measures such as quarantine, isolation or enact mandatory vaccine laws.

Every state and the District of Columbia has a law requiring children entering school to provide documentation that they have met the state immunization requirements.

Many states provide exemptions for medical, religious, or philosophical reasons (exemptions vary from state to state).

All states allow medical exemptions for those whose immune systems are compromised, who are allergic to vaccines, are ill at the time of vaccination, or have other medical contraindications to vaccines.

Exemptions based on philosophical or moral convictions are less common but are provided by 20 states.

Many states require health workers to be vaccinated; exemptions for medical, religious and philosophical reasons are available to them as well (they vary by state) but not for all diseases.

Many states have laws providing for mandatory vaccinations during a public health emergency or outbreak of communicable disease, especially ones with high morbidity or mortality rates. Exemptions for medical, religious or philosophical reasons are still available, however a person who refuses to vaccinate during the emergency may be quarantined.

At the federal level, no mandatory vaccination programs are specifically authorized, nor do there appear to be any regulations regarding the implementation of a mandatory vaccination program at the federal level during a public health emergency.

So, the answer to the question: are childhood vaccinations mandatory is: Yes and No. Yes, since most states require that children attending day care centers or schools provide documentation proving that they are up-to-date with their childhood immunization schedule, and no because those same states allow many exemptions for medical, religious and philosophical reasons. You may think that’s bad, but consider that in the other hand, child car seat laws are mandatory and do not, to the best of my knowledge, offer any exemptions for any reasons. Thus, to the best of my knowledge, vaccination laws are more relaxed than car seat laws, and car accidents are not contagious. You can judge for yourself if this is a good or bad thing, but the facts remain as described above.